Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

Appelboam, Andrew; Reuben, Adam; Mann, Clifford; Gagg, James; Ewings, Paul; Barton, Andy; Lobban, Trudie; Dayer, Mark; Vickery, Jane; Benger, Jonathan

doi:10.1016/s0140-6736(15)61485-4

Cited by 165 publications

(122 citation statements)

References 15 publications

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“…pressure of 40 mm Hg sustained for 15 s by forced expiration measured by aneroid manometer with the target pressure visible to the treating team). 1 The modified treatment was found to terminate SVTs in a significantly larger proportion of patients (43% of 214) than using conventional manoeuvres (17% of 214; P < 0.0001). As a consequence, significantly less patients in the study arm required adenosine (50% vs. 69%) or emergency anti-arrhythmic treatment (57% vs. 80%) to terminate the incident arrhythmia 1 and no differences in time to discharge from hospital.…”

Section: Cardiac Arrhythmias and Catheter Ablation Supraventricular Tmentioning

confidence: 86%

The year in cardiology 2016: arrhythmias and cardiac implantable electronic devices

Cappato¹,

Hindricks

Steffel

2017

Cardiologia Croatica

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Section: Cardiac Arrhythmias and Catheter Ablation Supraventricular Tmentioning

confidence: 86%

The year in cardiology 2016: arrhythmias and cardiac implantable electronic devices

Cappato¹,

Hindricks

Steffel

2017

Cardiologia Croatica

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“…A recent postural modification to the traditional Valsalva manoeuvre has been published with some conversion success. (41) The initial phase is performed with the patient sitting in a semirecumbent position, followed by laying the patient supine and passively elevating the patient's legs once the strain is released. This augments the venous return to the heart and accentuates the surge in cardiac output, thus triggering a more effective vagal response.…”

Section: Valsalva Manoeuvrementioning

confidence: 99%

Advanced Cardiac Life Support: 2016 Singapore Guidelines

Ching

Leong

Chua

et al. 2017

smedj

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Public access defibrillation PAD is another key intervention to improve the time to defi brillation for shockable rhythms in OHCA, through increasing the availability of automated external defi brillators (AEDs) in public places. Patients with shockable rhythms who received bystander defibrillation had 5.8 times the odds of survival compared to those who did not. Emergency ambulance response Prehospital emergency medical services should optimise the rapid dispatch of fi rst-responders who are trained in Basic Cardiac Life Support (BCLS) and AED use, as well as paramedics trained in advanced life support protocols, to the scene within eight minutes. This can be achieved through strategic preplacement of ambulances and related vehicular assets, as well as stratifi ed levels of responses for calls of different priority levels.Survival in OHCA is critically dependent on prompt institution of the fi rst three links of the chain of survival. Prehospital factors, including witnessed arrests, initial shockable rhythms, bystander defi brillation and emergency ambulance response times within eight minutes of collapse, have been ABSTRACT The main areas of emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are: early recognition of cardiac arrest and call for help; good-quality chest compressions; early defi brillation when applicable; early administration of drugs; appropriate airway management ensuring normoventilation; and delivery of appropriate post-resuscitation care to enhance survival. Of note, it is important to monitor the quality of the various care procedures. The resuscitation team needs to reduce unnecessary interruptions to chest compressions in order to maintain adequate coronary perfusion pressure during the ACLS drill. In addition, the team needs to continually look out for reversible causes of the cardiac arrest.

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“…16 An updated Cochrane review of the effectiveness of the Valsalva manoeuvre found a reversion rate varying from 19.4% to 54.3%. 17 Recently, Appelboam and colleagues 18 compared the standard Valsalva manoeuvre with a modified one consisting of performing the manoeuvre in the same semi-recumbent position but, immediately after the Valsalva strain, having patients lie flat and raising their legs to 45° for 15 seconds. The modified manoeuvre was found to be significantly more effective in terminating the SVT (43% v. 17%).…”

Section: Nonpharmacologic Measuresmentioning

confidence: 99%